Do patients of integrative anthroposophic pediatric inpatient departments differ? Comparative analysis to all pediatric inpatients in Germany considering demographic and clinical characteristics

Over the last 20 years, the term “Integrative medicine” has frequently been used in different healthcare sectors and systems to describe health services models that make “use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing” for the patient [1]. As a patient-centered, evidence-based, therapeutic paradigm it combines conventional and complementary approaches to foster patient health and addresses biological, psychosocial, spiritual, and environmental aspects of patients’ wellbeing [2]. Health care professionals of integrative medicine vary depending on the country’s health care system and its national and local regulations but commonly include physicians and non-medical therapists with are “succinct, explicit, and transparent for the integration and subsequent collaboration when treating patients” [3].

In western countries, integrative healthcare approaches have mostly emerged from primary care and, depending on the underlying healthcare system, found their way into secondary and tertiary patient care. In Europe, this has led to specialized hospitals and departments delivering integrative approaches with specializations in natural medicine, homeopathy, anthroposophic medicine or Traditional Chinese medicine [4‐11]. In the United States integrative treatment approaches are fostered by the National Center for Complementary and Integrative Health (NCCIH) and have led to the formation of the Consortium of Academic Health Centers for Integrative Medicine [12] which currently includes more than 50 programs and centers.

The clinical use of integrative approaches in pediatrics has increased in the past two decades [2, 4, 6, 13‐21]. Integrative medicine is used in children in the US [15, 17, 22‐25], Canada [26] and in Europe [4, 6‐9, 27, 28]. Integrative medicine for children is provided in private practices, outpatient wards, as well as inpatient wards [8].

Several recent studies report that 30–50% of parents of children with acute or chronic diseases state using integrative medicine for their child [11, 29‐31]. The use of integrative medicine seems to be more frequent (> 50%) in children with chronic diseases in the US [22, 32‐37]. Factors that are associated with the use of integrative medicine in children are the severity of their disease as well as parents’ use of integrative approaches [14, 38]. It is particularly prominent among affluent and educated parents [39]. A prospective cohort study on holistic pediatric services for inpatients and outpatients in oncology reports nausea, pain, insomnia, and agitation to be the most frequent goals for consultation of integrative medicine in children, as well as questions about herbs, dietary supplements, diet and nutrition, and mind-body therapies, such as guided imagery and biofeedback, and massage [17]. A recent review found a growing establishment of pediatric integrative medicine in academic hospitals in the US and describes pediatric integrative medicine to be a much-needed subspecialty to meet the needs of today’s children [2]. Integrative medicine is especially relevant for pediatric gastroenterology, pain medicine, neurology, oncology, pulmonary and other subspecialties in the US [2]. A very recent study in a large pediatric hospital in the US [19] found that anecdotal and scientific evidence supported the use of integrative approaches in the context of pediatrics.

Two recent publications by Eckert et al. [6] and Anheyer et al. [4] describe the successful implementation of integrative pediatrics at pediatric hospitals in Germany (St Marien, Landshut, Elisabeth hospital Essen) for inpatient and outpatient services. Modalities applied are TCM, relaxation, hypnosis, reflexology, compresses and poultices, aromatherapy, homeopathy, yoga and herbal medicine as well as phytotherapeutic approaches [4]. Optional single-remedy-homeopathy is being integrated into routine pediatric service at the Dr. von Hauner’s Children’s University hospital in Munich [40, 41].

A well-known and frequently used integrative whole systems approach in Germany is anthroposophic medicine [42]. Anthroposophic medicine is based on a holistic understanding of humans and nature and of disease and treatment. The anthroposophic approach is based on a concept of four levels of formative forces and on the model of a three-fold human constitution [42]. It uses medical remedies derived from plants, minerals, and animals, art therapy, eurythmy therapy, and rhythmical massage, counseling, psychotherapy, and specific nursing techniques such as external embrocation [43‐45]. Anthroposophic medicine has established therapeutic recommendations for the treatment of children suffering acute gastroenteritis [44], pseudocroup [43], bronchitis [45] and epilepsy. In Germany, there are two pediatric inpatient departments with a distinct focus on integrative anthroposophic medicine, at the Gemeinschaftskrankenhaus Herdecke (community hospital) and the Filderklinik Filderstadt [8, 10]. Even though there is a growing interest of parents on integrative pediatrics, little is known about the inpatient treatment infra-structure, disease burden and patient characteristics.

Until today, most of the available information on pediatric inpatients using integrative medicine is based on qualitative analyses [4, 6], while systematic quantitative analyses of patient characteristics and diagnosis parameters are lacking. Considering the growing demand for integrative approaches and the increasing number of institutions offering and implementing integrative medicine for children [17], it is relevant from a public health perspective to investigate which kind of patients make use of integrative approaches in Germany. In particular, it is of interest whether these patients differ from the entirety of pediatric patients in Germany concerning clinical and demographic characteristics. It has been suggested by previous studies that especially patients with severe [14, 38] and chronic diseases use integrative approaches [22, 32‐37] and patients may be willing to travel longer distances to be treated in a hospital with special offers [46] it would be interesting to known, whether these patients are also willing to travel a longer distance to gain integrative treatment, such as anthroposophic medicine. Furthermore, earlier studies have shown that there seems to be a difference between Western Germany and former Eastern Germany considering the use of integrative medicine [47], consequently it would be relevant to know whether there are similar patterns for integrative pediatric patients.

Therefore, the current study aims to investigate patient characteristics and diagnosis parameters of integrative anthroposophic pediatric inpatients and to compare them to data from all pediatric wards in Germany. Our hypotheses were that:

The aim of our study was to investigate patient characteristics and diagnosis parameters of integrative anthroposophic pediatric inpatients and compare them to data from all pediatric wards in Germany. We found no difference between pediatric patients in the integrative anthroposophic hospitals and the entirety of all pediatric hospitals concerning age and gender distribution. We furthermore hypothesized that patients treated in these department do not differ from the entirety considering clinical characteristics, such as the frequency of the ICD-10 diagnoses. Our findings did not support this hypothesis; in fact, our data indicated that the situation is much more complex. While there are disease categories that show great similarities in their frequencies compared to the entirety of all pediatric departments in Germany such as diseases of the skin and subcutaneous tissue, congenital malformations and deformations and chromosomal abnormalities, we found comparatively higher frequencies for perinatal, neurological and behavioral diseases. Moreover, we found lower frequencies for diseases from the field of general pediatrics such as digestive diseases, respiratory diseases, and infectious and parasitic diseases. Our data showed a broad catchment area for the integrative anthroposophic pediatric hospitals with a significantly higher number of patients from the former Western part of Germany compared to the former Eastern part. We were furthermore able to demonstrate, that patients with a long travel distance to either one of the integrative anthroposophic hospitals have chronic diseases and patients with a short travel distance predominantly acute disease.

In line with our hypothesis, pediatric inpatients of integrative anthroposophic inpatient departments do not differ from the entirety of pediatric inpatients in Germany with regard to sociodemographic characteristics. Considering clinical characteristics, the situation seems to be more complex and patterns of similarities and differences are heterogenous. The integrative anthroposophic pediatric departments show a broad catchment area all over Germany, with a majority of patients being from former Western Germany. Larger catchment areas for the integrative anthroposophic pediatric hospitals are merely covered by severe and chronic diseases.